两支冠状动脉血管同时闭塞致急性心肌梗死一例

急性心肌梗死（AMI）常因某支冠状动脉（冠脉）粥样硬化斑块破裂、痉挛及血栓形成导致血管闭塞所致。急性冠脉综合征时常有多部位的斑块不稳定，然而2支冠脉血管同时闭塞引起AMI，则非常罕见。我们观察到1例两支冠脉血管同时闭塞导致AMI的患者，急诊时未能明确，仅对1支冠脉行急诊介入治疗，后期才得以证实为双支血管同时闭塞。     

青年急性心肌梗死冠脉造影结果性别对比分析

目的 探讨青年心肌梗死冠脉血管病变的性别差异.方法 回顾性分析我院2005年1月至2010年12月因急性心肌梗死行选择性冠脉造影的青年患者466例,了解其临床情况并仔细分析其血管病变情况.结果 466例患者根据性别不同分为两组,男性436例,女性30例,两组均以ST段抬高型心肌梗死为主（分别为86.47％和73.33％）,均有较多患者无明显冠脉血管病变（分别为10.55％和20.00％）,但可能因病例数有限,均无明显差异.女性患者左冠优势型明显多于男性（分别为30.00％和10.55％,P＜0.01）,两组冠脉血管起源异常发生率、肌桥发生率无明显差异.两组冠脉血管的钙化、迂曲、偏心、成角、溃疡、撕裂、闭塞、血栓、扩张的发生率无明显差异.但男性患者冠脉岔口病变发生率明显高于女性（分别为61.01％和40.00％,P＜0.05）.结论 青年男女心肌梗死患者血管病变形态有一定的差异,对冠脉病变再血管化治疗方案有一定影响.     

2支冠状动脉同时急性闭塞的急性ST段抬高型心肌梗死诊治经验

本研究主要探讨2支冠状动脉同时急性闭塞的急性ST段抬高型心肌梗死的诊治要点。回顾性分析2016年11月-2017年12月我院连续诊治的3例前降支和右冠同时急性闭塞患者的诊治经过,总结其临床症状、心电图表现、造影特点和急诊PCI手术策略与预后关系。第1例患者先处理右冠,后处理前降支,前降支支架后出现致死性无复流;第2例患者先处理右冠,出现致死性再灌注性心律失常;第3例患者先处理前降支,后处理右冠,没有出现并发症,1年随访无心脏主要不良事件。前降支和右冠同时急性闭塞的急性ST段抬高型心肌梗死,避免先处理更容易出现严重再灌注损伤反应的右冠,有可能提高成功率。     

急性心肌梗死多支冠状动脉同时闭塞一例

<正>1临床资料患者男性,60岁。主因"突发胸痛17h"于2014年5月5日16:00入院。患者入院前17h于睡眠时突发胸骨后压榨样疼痛,向左肩及左上肢内侧放射,伴大汗、气短,症状持续不能缓解,5h后就诊当地县医院,行心电图示(图1):右束支传导阻滞,急性下壁、右心室心肌梗死,诊断急性下壁、     

青年男性急性心肌梗死88例临床分析

目的:探讨青年男性急性心肌梗死(AMI)患者的临床病变特点。方法:回顾性分析1578例不同年龄和不同性别AMI患者临床特征及冠状动脉造影结果。结果:≤40岁男性AMI患者88例。主诉多为胸痛,AMI梗死范围以前壁多见。与老年男性比较,危险因素以超重和吸烟为著。冠状动脉正常者较多,以单支病变为主,合并左主干病变较少。经皮冠状动脉介入(PCI)是主要的治疗手段,患者预后较好。结论:AMI发病年轻化,青年AMI患者中男性占绝大多数,病因以冠状动脉粥样硬化为主,其危险因素和冠状动脉病变特点与老年男性不同,临床医生应加以重视。     

左旋支闭塞所致非 ST-T 改变急性心肌梗死的临床探讨

目的探讨与左旋支闭塞相关的非 ST-T 改变急性心肌梗死的临床特点.方法回顾性分析确诊为与左旋支闭塞相关的急性心肌梗死患者100例的心电图,将其分为 ST-T 改变组(n=64)和非 ST-T 改变组(n=36),再与其冠状动脉造影结果分析比较.结果非 ST-T 改变组与 ST-T 改变组比较,肌酸磷酸激酶同工酶值较低(17.7±2.2比18.5±0.9,P<0.01),而右优势型和均衡型伴左旋支中、远端阻塞的发生率较高(86.1%比45.3%,P<0.01).两组30d 死亡率(4.7%比0%)比较,差异无统计学意义(P >0.05).结论与左旋支闭塞相关的急性心肌梗死伴非 ST-T 改变发生率相对较低,临床特点缺乏,易导致漏诊、误诊,值得临床关注.     

青年急性心肌梗死患者危险因素及冠状动脉病变特点分析

目的 探讨青年急性心肌梗死（AMI）患者的危险因素及冠状动脉病变特点.方法 纳入2008年1月至2012年6月期间解放军总医院心血管研究所青年（≤45岁）AMI患者150例,作为青年AMI组;纳入同期45岁以上AMI患者160例,作为老年AMI组,比较两组患者的临床特征和冠状动脉造影结果.结果 与老年AMI组相比,青年AMI患者男性比例和吸烟比例较高（分别为：96.0% vs.75.6%和62.7% vs.35.6%）,高血压和高脂血症比例较低（分别为37.3% vs.49.4%和40.0% vs.66.9%）,差异有统计学意义（P＜0.05）;通过对132例青年AMI的冠脉造影结果进行分析（占50.0%）,有8例（6.1%）未见明显冠脉狭窄,以单支病变为主;老年组则以多支病变为主（占74.8%）.结论 与老年AMI相比,青年AMI患者合并症发生率较低,但吸烟比例较高,同时青年AMI患者较老年AMI的病变累及冠脉少,多以单支病变为主.     

青年急性心肌梗死32例分析

为探讨青年急性心肌梗死 (AMI)患者的临床特点 ,我们对 32例青年 AMI患者的临床资料进行分析 ,并与 32例老年AMI患者进行了比较。现报告如下。临床资料 :4 0岁以下 AMI患者 32例 (青年组 ) ,5 5岁以上 AMI患者 32例 (对照组 )。两组临床表现、心电图及心肌酶学改变均符合 AMI诊断标准。两组基本情况见表 1。表 1　两组病例基本情况比较 (例 )组别男 /女吸烟肥胖高血脂高血压青年组 3 2 /0 * 2 7* 15 * 16* 9*老年组 2 0 /12 10 910 16　　注 :与老年组比较 ,*P<0 .0 5青年组发病前均有明确的诱发因素 ,其中劳累 14例 ,饮酒 9例 ,情…     

青年急性心肌梗死的临床分析

急性心肌梗死 (AMI)多发于 4 0岁以上的中老年人 ,但近年来 ,青年人发生 AMI有增多趋势。本文对 12例 4 0岁以下青年人 AMI进行临床分析 :1　资料与方法1.1　一般资料本组 12例患者均为青年男性 ,年龄 32～ 4 0岁 ,平均 37.2± 3.5岁 ,均符合 WHO诊断标准。 12患者中 9例 (75% )有冠心病危险因素 ,其中高血压 4例(33.3% ) ,高血脂 7例 (58.3% ) ,吸烟 10例(83.3% ) ,肥胖 7例 (58.3% )。本组 9例就诊时有明显的胸骨后疼痛伴闷压感或放射痛 ,3例首诊时被误诊 ,但在发病 2～ 3天后 ECG检查时确诊。 3例(2 5% )出现偶发室早 ,经用利多卡…     

Acute myocardial infarction caused by simultaneous occlusion of the right coronary artery and the left anterior descending coronary artery probably due to coronary spasm: a case report

A 56-year-old man had an attack of chest pain associated with ST-segment elevation in both the inferolateral and anteroseptal leads on electrocardiography. Emergency coronary angiography showed thrombus in the mid right coronary artery and total occlusion in the distal left anterior descending coronary artery. Intravenous heparin infusion and antiplatelet therapy were given without other coronary intervention. After 1 week, repeat coronary angiography showed neither significant stenosis nor thrombus in the coronary arteries. Severe coronary artery spasm in the left coronary artery was induced by the provocation test with intracoronary injection of 50 microg acetylcholine. He had an uneventful hospital course. This unique case demonstrated intracoronary thrombus formation in the right coronary artery and left anterior descending coronary artery simultaneously due to suspected coronary spasm.     

Double vessel acute myocardial infarction showing simultaneous total occlusion of left anterior descending artery and right coronary artery

Simultaneous double vessel acute myocardial infarction (AMI) is extremely rare and usually has poor clinical outcomes. Management of this complicated condition is challenging and time-limited. The case of a 46-year-old Taiwanese man with simultaneous anterior and inferior wall AMI is reported. Rapid deterioration of clinical condition with ventricular fibrillations (VF), cardiogenic shock and asystole developed before catheterization. Coronary angiogram revealed simultaneous total occlusion of left anterior descending (LAD) and right coronary arteries (RCA). Frequent VF attack was still noted after diagnostic catheterization. After cardiopulmonary resuscitation, immediate percutaneous coronary intervention of the LAD and RCA, and intra-aortic balloon counterpulsation was inserted. Due to intractable heart failure and cardiogenic shock, extracorporeal membrane oxygenation was performed. Rabdomyolysis with acute renal failure was also noted with hemodialysis treatment. Thirty-one days after hospitalization, he was discharged with a New York Heart Association functional class III heart failure, without hemodialysis.     

Acute myocardial infarction showing total occlusion of right coronary artery and thrombus formation of left anterior descending artery

A 33-year-old Japanese man had an attack of chest pain associated with ST-segment elevation in the inferolateral leads on his electrocardiogram. Emergency coronary angiography showed total obstruction in the mid right coronary artery (RCA) and a movable thrombus in the proximal left anterior descending artery (LAD). We performed emergency percutaneous transluminal coronary angioplasty (PTCA) for the RCA lesion. The operation was successful and we then conducted intracoronary thrombolysis (ICT) with tisokinase 6,400,000 IU for the LAD thrombus. Its size was reduced by ICT. He had an uneventful hospital course. After 1 month, repeat coronary angiography showed no significant stenosis in the RCA nor thrombus in the LAD. A coronary spasm provocation test was performed using acetylcholine. Coronary spasm in the LAD was induced by an intracoronary injection of 100 microg acetylcholine. In this case, we observed a unique condition suggesting simultaneous double coronary artery occlusion.     

A case of acute myocardial infarction due to simultaneous occlusion of the right coronary artery and left anterior descending coronary artery

We reported a rare case of a 53-year-old man who experienced acute myocardial infarction due to simultaneous occlusion in the right coronary artery and the left anterior descending coronary artery. He also experienced thromboembolisms on several occasions. So anticoagulant therapy is necessary for patients with exceedingly poor LV function.     

A comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups. When patients with a circumflex artery-related infarct were stratified according to the presence or absence of abnormal R waves in lead V1 or V2, the abnormal R wave group had more admission ST elevation (p = 0.025), a larger infarct (p less than 0.05) and more extensive coronary artery disease (p = 0.027). In fact, all patients with a circumflex artery-related infarct and an abnormal R wave in lead V1 had multivessel disease. An abnormal R wave in lead V1 had a 96% specificity for circumflex versus right coronary artery-related infarction but a sensitivity of only 21%. Discriminate function analysis of all admission historical and ECG variables identified inferior and lateral ST elevation as independent predictors of circumflex artery-related infarction...     

Acute myocardial infarction and ischemia in the left anterior descending artery territory in a patient with single coronary artery

This report describes a 77-year-old woman with a single coronary artery who suffered an acute anterior wall myocardial infarction. The single coronary artery arose from the right coronary artery through the transverse trunk, and there were no other cardiovascular anomalies. Coronary angiography did not reveal significant coronary artery stenosis in the left anterior descending artery. The patient was treated medically in the acute phase. She developed typical angina and evidence of myocardial ischemia, and underwent successful coronary artery bypass grafting in the chronic phase with anterior chest pain.     

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.     

Acute proximal left anterior descending coronary artery occlusion presenting with Normal ECG: A case report

The middle‐aged male was diagnosed with “acute anterior wall myocardial infarction” based on clinical symptoms, laboratory examination, and coronary angiography (CAG), but his ECG showed no significant change in QRS wave or ST‐T within 6 h of admission. Thus, a perfect explanation with the existing theory is difficult, and only the case is presented here.